gms | German Medical Science

Background: Complicated approval procedures result in time delays between the definition of a medical indication for ranibizumab treatment in active neovascular age-related macular degeneration (AMD) and the initiation of treatment. This study aimed to evaluate changes in visual acuity and central retinal thickness over time.

Methods: 69 patients indicated for first-time ranibizumab treatment, and 21 patients with necessary re-treatment, were included. Visual acuity and spectral domain optical coherence tomography (SD-OCT) central retinal thickness at the time of the indication examination were compared to values at the first-time treatment and during recurrent ranibizumab treatment.

Results: Thedelay between indication and treatment was significantly higher for patients with compared to those without vision-loss (31.6 +/- 20.5 vs. 24.0 +/- 28.3 days, p=0.012). Increase in OCT central retinal thickness was 50.4 +/- 92.8 µm for patients with vision loss compared to 5.1 +/- 63.4 µm for those without vision loss, p=0.029. A 1.1 logMAR line difference in vision loss was significant at p=0.01 for patients with a delay in treatment of less than or equal to 28 days compared to those with a delay of more than 28 days.

Conclusions: Even though average visual decay was slow at about one logMAR line over 110 days, individual patients (8.7%) experienced rapid loss of one or more lines within 21 days. Administrative procedures should therefore be expedited so that delays do not exceed two weeks for the sake of vision preservation in individual patients.